Do I Still Need Regular Breast Exams

After Treatment for Breast Cancer?

by Vladimir Lange, MD

Every woman who has had breast cancer
should have a mammogram once a year,
regardless of age.

Even after the most complete
treatment for breast cancer,
there’s always a chance that
cancer will recur. Most recurrences
happen two or three years after surgery.
The longer you go without a recurrence,
the greater are your chances of remaining
free of the disease. But you can
never say that the cancer has been completely
cured.

Because of this possibility, you need
regular follow-up visits with a healthcare
professional. It could be your family
physician, your oncologist, or your breast
surgeon. What’s important is to have a
single person in charge of the follow-up
care. Usually, you’ll be seen as often
as every few weeks immediately after
treatment, and perhaps only every six
months later on. There is no “right”
schedule. Eventually, you will probably
be down to a single annual visit.

What does follow-up care involve?
Most physicians suggest a physical
examination to look for signs of local recurrence
– new lumps within the breast
after lumpectomy, or tiny, hard nodules
in the surgical scar after mastectomy.

In addition, mammography will be
scheduled on a regular basis, and you
may have a number of blood tests that
will assess the function of your liver,
bone marrow, and other organs, and a
chest X-ray. Other tests, such as CEA
(a protein found in the blood of people
with cancer) and bone scans, are not
used routinely.

You need to become familiar with the new look and feel of
your breasts so that you can report any changes promptly.

Currently, many experts feel that
there is little to be gained by performing
multiple tests on people who are
asymptomatic – that is people who have
no symptoms. Such tests may detect
a recurrence a few months earlier, but
earlier diagnosis will not change the
outcome of whatever treatment you
might need. So you can expect to have
fewer and fewer tests as the years pass
after your initial treatment.

Breast Self Examination
BSE is
particularly important for women at
higher risk of breast cancer – and that
includes you and your first-degree relatives.
You need to become familiar with
the new look and feel of your breasts so
that you can report any changes promptly.

BSE is not a skill that you can learn
from a brochure or a shower card. The
best way to learn it is from your healthcare
provider, or from a good breast
self exam DVD.

A thorough BSE should include
the following:

LookingUsing a mirror, check the
shape and size of your breasts and the
color and texture of your skin, first with
your arms down, then with your arms
in the air. Try to learn what’s normal
for you so that you can spot any changes
immediately.

Feeling Lie down with a folded towel
under your shoulder. Extend the arm
out at an angle to spread the breast tissue
more evenly. Use three middle
fingers to examine the entire breast area.
Make three dime-sized circles. One
just lightly, one deeper, and one deeper
still. This will enable you to check the
full thickness of your breast. When
you’ve finished, lower your arm and
examine your armpit for possible lymph
node enlargement.

If you had a mastectomy, you are
not likely to find a lump within the flap
tissue used for reconstruction. Local
recurrences are more likely to appear
as tiny, firm beads along the incision
line. If you had a lumpectomy, you will
probably feel irregular lumpiness at the
surgical site shortly after the lumpectomy
heals.

Clinical Breast Examination
CBE
will be part of your regular checkups.
The physician will probably spend additional
time examining the scar and
areas where enlarged lymph nodes may
be found – under the arms and around
the collar bones.

Mammography
Every woman who
has had breast cancer should have a
mammogram once a year, regardless of
age. If you had a lumpectomy, the films
may be more difficult to interpret, so
make sure that previous mammograms
are available for comparison. If you
had a mastectomy, you should have
mammograms of the other breast. If
you are sensitive near the post-surgical
scar, ask the technologist for a Mammopad
– a soft sheet of special padding
that fits on the mammography device.

MRI
For women with especially
dense breasts, or women who present
unusual diagnostic challenges, MRI is
an effective option. In fact, the American
Cancer Society now recommends
that all women at high risk of breast
cancer (which includes women who
already had breast cancer before) should
have screening with MRI every year.

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Editor’s Note: Dr. Vladimir Lange, a graduate
of Harvard Medical School, is a leading
expert in helping women and their families
in their battle with breast cancer. His wife,
Mandy, also a physician, is a breast cancer
survivor.